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Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter

Published online by Cambridge University Press:  21 May 2015

Ian G. Stiell ,
Catherine M. Clement ,
Jeffrey J. Perry ,
Christian Vaillancourt ,
Cheryl Symington ,
Garth Dickinson ,
David Birnie  and
Martin S. Green
Ian G. Stiell*
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Catherine M. Clement
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.
Jeffrey J. Perry
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Christian Vaillancourt
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Cheryl Symington
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.
Garth Dickinson
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
David Birnie
Affiliation:
University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ont.
Martin S. Green
Affiliation:
University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ont.
*
Clinical Epidemiology Unit, F657, Ottawa Hospital, 1053 Carling Ave., Ottawa ON K1Y 4E9; istiell@ohri.ca

Abstract

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Objective:

There is no consensus on the optimal management of recent-onset episodes of atrial fibrillation or flutter. The approach to these conditions is particularly relevant in the current era of emergency department (ED) overcrowding. We sought to examine the effectiveness and safety of the Ottawa Aggressive Protocol to perform rapid cardioversion and discharge patients with these arrhythmias.

Methods:

This cohort study enrolled consecutive patient visits to an adult university hospital ED for recent-onset atrial fibrillation or flutter managed with the Ottawa Aggressive Protocol. The protocol includes intravenous chemical cardioversion, electrical cardioversion if necessary and discharge home from the ED.

Results:

A total of 660 patient visits were included, 95.2% involving atrial fibrillation and 4.9% involving atrial flutter. The mean age of patients enrolled was 64.5 years. In total, 96.8% were discharged home and, of those, 93.3% were in sinus rhythm. All patients were initially administered intravenous procaïnamide, with a 58.3% conversion rate. A total of 243 patients underwent subsequent electrical cardioversion with a 91.7% success rate. Adverse events occurred in 7.6% of cases: hypotension 6.7%, bradycardia 0.3% and 7-day relapse 8.6%. There were no cases of torsades de pointes, stroke or death. The median lengths of stay in the ED were as follows: 4.9 hours overall, 3.9 hours for those undergoing conversion with procaïnamide and 6.5 hours for those requiring electrical conversion.

Conclusion:

This is the largest study to date to evaluate the Ottawa Aggressive Protocol, a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. Our data demonstrate that the Ottawa Aggressive Protocol is effective, safe and rapid, and has the potential to significantly reduce hospital admissions and expedite ED care.

Keywords

atrial fibrillationatrial flutteremergency departmentcardioversionelectrical cardioversionarrhythmias
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 3 , May 2010 , pp. 181 - 191
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

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